- the health of the expectant mother;
- problems during pregnancy;
- Fetal condition.
There is also not one method of anesthesia with her (general, epidural and spinal anesthesia is used today).
In most foreign countries, labor by caesarean section is performed under epidural or spinal anesthesia, but note that the indicator of the latter's use is constantly growing and often dominates the epidural.
Each method is "endowed" with its own advantages and disadvantages, and therefore with indications and contraindications as well (all this must be taken into account by the doctor when choosing the method of anesthesia). Today we will talk in more detail about spinal (or spinal) anesthesia.
Spinal anesthesia with caesarean section
The introduction of an anesthetic between the vertebrae in the lumbar region of the back (into the subarachnoid space) is called a spinal anesthesia. With this method of anesthesia, a puncture of the dense shell that surrounds the spinal cord (in comparison with epidural anesthesia in this case the needle is introduced a little deeper), that is, the puncture site is the lumbar region. In cerebrospinal fluid, a local anesthetic is injected through the needle through which the spinal canal is filled, so that any manifestations of sensitivity are "blocked" in this region.
Most often, the puncture (puncture) of the spinal space is carried out in the prone position on the side, and if the mother has an opportunity, it is advisable to press the legs to the stomach. Less common procedure is in sitting position.
The advantages of spinal anesthesia for cesarean section
- the woman in labor is fully conscious;
- the rapid onset of anesthesia, which is very necessary in case of emergency emergencies;
- 100% anesthesia;
- You can start preparing for surgery (abdominal surgery) as early as 2 minutes after the pain medication is administered;
- due to the fact that with spinal anesthesia it is possible to accurately determine the place of needle insertion, it is easier on technique than general or epidural;
- Compared with epidural anesthesia, in this case, a thinner needle is used to administer an anesthetic;
- absence of toxic reactions from the cardiovascular system or the central nervous system (as is possible with epidural anesthesia);
- there may be very little impact on the fetus of the injected anesthetic in small volumes - only about 4 ml;
- Thanks to the fact that the muscles achieve complete relaxation, the surgeon gets excellent conditions for his work.
Disadvantages of spinal anesthesia with caesarean section
- occurrence of moderate post-puncture headache lasting 1-3 days in the frontotemporal area (the frequency of its occurrence depends largely on experience of physicians);
- the duration of the blockade lasts only 2 hours, which in principle is sufficient to conduct the entire operation;
- if not all preventive measures have been taken, blood pressure may decrease due to a sharp onset of action;
- there may be more serious neurological complications in cases where the effect of spinal anesthesia has been prolonged. If the catheter was not positioned correctly, damage to the horse's tail (continuation of the nerve roots of the spinal cord, which begin with the lumbar segments) is possible. Incorrect insertion of the catheter requires additional doses of anesthetic, which can provoke a prolonged blockage;
- in case the total dose of anesthetic was not calculated correctly, additional injections can not be made. It is necessary to re-insert the catheter - this will help to avoid such complications, as a traumatization of the spinal cord as a result of its rupture or extension.
And yet spinal anesthesia less than the rest affects the fetus, it guarantees a higher protection of the body from postoperative pains, and it is relatively cheaper. In many developed countries, spinal anesthesia with caesarean section (along with epidural) is widespread and is recognized as a fairly safe method of anesthesia (many doctors have recognized it as the best technique of anesthesia).